Informed Consent Example

/ am at least 18 years of age and completing this questionnaire constitutes my informed consent.

Dear Student,

I am a doctoral student in the Seattle Pacific University’s Counselor Education program and am conducting this research for my dissertation. The purpose of my study is to explore counseling students' thoughts about spiritual and religious issues as they relate to counseling. You were selected because of your standing as a master's student in counseling. Your participation in this study is completely voluntary and, if you choose to participate, you will be asked to complete the Students'Attitudes of Spiritual/Religious Issues in Counseling Scale. This instrument includes questions about your relevant thoughts, reactions, and demographic information. It will take about 15 minutes to complete. Your participation is invaluable to this research and is greatly appreciated.

• Your participation is completely voluntary. You may refrain from participating without any impact on your grade, class standing, or status in the program. Your instructor is in no way associated with this study. If you choose not to participate, you may leave the classroom before the questionnaire is distributed or you may remain in your seat and return an unanswered questionnaire.

• If you agree to participate, the questionnaire will be given to you. It is essential that your identity remain anonymous, so please do not write your name on the questionnaire.

• There are no right or wrong answers, so please answer all questions honestly. If you are unsure about how to answer a question, please choose what you feel is the best response.

• The results of this study will be used to inform the counseling profession about students' views on these issues and will help professionals determine how educational endeavors can be best tailored to meet students' needs. The results will be reported in the researcher's dissertation, in a follow up article, and in a presentation at a national conference. However, all reports will be of the combined data from all participants and will not include your name or any other identifying information.

• The benefits for your participation include a heightened awareness of spiritual/religious issues in counseling and a sense of contributing to your profession. There are no known risks associated with your participation in this study. However, if any of the questions make you feel uncomfortable, please feel free to leave them blank. You may also discontinue your participation at any time. If your participation in this research project stimulates issues that require further discussion, you can seek student counseling services at The Student Counseling Center by calling (206) 281-2657.

• Your privacy and the research records will be kept confidential to the extent of the law. Authorized research personnel, employees of the Department of Health and Human Services, the SPU Institutional Review Board (IRB) and its staff, the IRB and staff at your university, and other individuals, acting on behalf of SPU and your university, may inspect the records from this research project. However, the anonymous nature of this study prohibits identifying any individual from his or her responses.

• If you have any questions about this questionnaire, please contact the researcher, ______at phone______or by email at . The SPU professor who is overseeing this dissertation research is ______. He can be reached at phone number______or by email at .

• This research study has been reviewed and approved by the SPU Institutional Review Board (IRB # ______; valid through ______). Questions or concerns about research participants' rights may be directed to the SPU IRB office. The phone number is206.281.2201.

After you read this letter, you may leave the classroom if you choose not to participate. If you remain seated, you will be given a copy of the questionnaire. Your completion of the questionnaire constitutes your informed consent to use your results. If after receiving the questionnaire, you choose not to complete it, please return it unanswered. When you are finished, return the questionnaire by placing it face down in the designated return area. You may keep this letter for your records.

Thank you very much for your time and effort in completing this questionnaire. Your participation is sincerely appreciated and will ultimately help professionals in higher education meet counseling students' needs.

Sincerely,

Name

Address

Contact Information

INSTRUCTIONS TO INVESTIGATORS:

Even when written informed consent is not mandatory (conditions of exemption), it remains necessary to notify each participant as to the purpose of their participation, how their data will be used and their confidentiality will be maintained. This template thus acts to summarize the necessary information when written consent will not be collected.

Preparing the Informed Consent Form

  1. Use the format and headings given in the template. These headings are required by the Federal Office of Human Research Protections.
  2. The SPU logo must be present.
  3. After your IRB application is approved you will receive an IRB number and valid through date. These must be added to your informed consent.
  4. Use language that is appropriate for an eighth grade reading level. You can test the reading level of your document in MS Word. See for more suggestions for simplified writing.
  5. Remember, you are speaking TO the participant. Make the language as clear and consistent as possible.
  6. Do not use the word “I” except at the very end, since it can be interpreted as being coercive.

Reviewing the Informed Consent Form with Participants

  1. Prepare a copy for both the participant and the PI.
  2. Read through the Informed Consent with the participant.